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The Optimal Treatment for Hypothyroidism: Ken Woliner, MD

Dr. Ken Woliner Shares His/Her Approach to Treating an Underactive Thyroid

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Updated May 19, 2014

The Optimal Treatment for Hypothyroidism: Ken Woliner, MD

Dr. Ken Woliner believes that symptoms, tests, and monitoring all factor into hypothyroidism diagnosis and treatment.

In discussing "optimal treatment of hypothyroidism," Dr. Woliner also wants to warn patients about three unusual situations that he's seen recently.
First, a new patient to my practice, before seeing me, accidentally poisoned himself by overdosing on USP Iodine Tincture as a self-treatment for his hypothyroidism. He developed Jod-Basedow Disease, and unfortunately died before I could get him to a cardiologist to put in an implantable cardioverter-defibrillator [9]. Second, a body-builder who was not a physician (he called himself a naturopath even though he never went to naturopathy school, got a degree, or had a license to practice naturopathic medicine), got access to a real physician's DEA number and was prescribing thyroid hormone, anabolic steroids, and human growth hormone (hGH) to unsuspecting patients. His victims were also forced to buy these prescription medications from him directly, at inflated prices, rather than being able to use a pharmacy of their choice. Though he was arrested for the unlicensed practice of medicine and trafficking in anabolic steroids, there are other bad actors out there [10]. Lastly, I've seen one case of dinitrophenol poisoning, in a dieter who purchased this dangerous chemical from the Internet. In this case, she did survive, but others exposed to this deadly weight-reducing drug were not so lucky [11]. Those situations are not what I call "optimal treatment," so I implore patients to coordinate treatment with an honest and knowledgeable physician.
To summarize, Dr. Woliner believes that there are many "ranges of lab tests" out there, and, he says, the lab will use a reference range that compares to you to 95% of the population, many of whom are fatigued, overweight, and sick enough to be treated with prescription antidepressants and cholesterol lowering meds [12]. Says Dr. Woliner:
Doctors that are still able to, and are willing "to think," realize that "common-normal" isn't the same as "optimal-normal", and will adjust ranges of the TSH, free T4, free T3, Reverse T3/Total T3 ratio, and thyroid antibodies to those that are more appropriate [13]. But "secondary hypothyroidism" and various types of "thyroid hormone resistance" are still missed by these narrowed ranges, so I emphatically feel that listening to my patients' symptoms, performing periodic physical exams, and monitoring for adverse effects to be far more effective than any one lab test in achieving "optimal treatment of hypothyroidism."

Kenneth N. Woliner, M.D., A.B.F.M. is a board-certified holistic physician. His practice, Holistic Family Medicine, is located in Boca Raton, Florida.

Holistic Family Medicine website: www.holisticfamilymed.com.

Source: Email interview with Ken Woliner, MD - December 2010

References

[1] Wiersinga, WM. "Systemic Manifestations of Hypothyroidism. Chapter 9, Sections 9.5 - 9.7" in http://www.thyroidmanager.org/Chapter9/9-frame.htm Leslie DeGroot, editor. Accessed December 16, 2010.
[2] Refetoff S, Franklyn JA, and Shephard M. "6E - Evaluation of Thyroid Function in Health and Disease" in http://www.thyroidmanager.org/Chapter6/6-frame.htm Leslie DeGroot, editor. Revised 21 September 2000.
[3] Haymart MR. The role of clinical guidelines in patient care: thyroid hormone replacement in women of reproductive age. Thyroid. 2010 Mar;20(3):301-7. PubMed PMID: 20146654; PubMed Central PMCID: PMC2835384.
[4] Cini G, Carpi A, Mechanick J, Cini L, Camici M, Galetta F, Giardino R, Russo MA, Iervasi G. Thyroid hormones and the cardiovascular system: pathophysiology and interventions. Biomed Pharmacother. 2009 Dec;63(10):742-53. Epub 2009 Oct 13. Review. PubMed PMID: 19917524.
[5] Bartalena L, Bogazzi F, Martino E. Adverse effects of thyroid hormone preparations and antithyroid drugs. Drug Saf. 1996 Jul;15(1):53-63. Review. PubMed PMID: 8862963.
[6] Park YJ, Yoon JW, Kim KI, Lee YJ, Kim KW, Choi SH, Lim S, Choi DJ, Park KH, Choh JH, Jang HC, Kim SY, Cho BY, Lim C. Subclinical hypothyroidism might increase the risk of transient atrial fibrillation after coronary artery bypass grafting. Ann Thorac Surg. 2009 Jun;87(6):1846-52. PubMed PMID: 19463607.
[7] Franklyn JA, Betteridge J, Daykin J, Holder R, Oates GD, Parle JV, Lilley J, Heath DA, Sheppard MC. Long-term thyroxine treatment and bone mineral density. Lancet. 1992 Jul 4;340(8810):9-13. PubMed PMID: 1351654.
[8] Marconi Transatlantic Wireless Telegraph. "Medicine Aids Girl Who Never Grew Up; ; Short Treatment Causes Increase in Height and General Physical Improvement. NEW VOCABULARY ACQUIRED Although 23, She Formerly Used Only Three or Four Words -- Now She Is Loquacious." NY Times. 27 December 1908.
[9] Goday-Arnó A, García Rico A, Martínez-Riquelme A, Cano-Pérez JF. [Graves Basedow disease following treatment with magistral formulae for obesity. Jod-Basedow phenomenon?]. Rev Clin Esp. 1996 Aug;196(8):536-8. Spanish. PubMed PMID: 8984540.
[10] FDA Enforcement Story 2005. "Smuggling, Selling, and Distributing hGH" http://www.fda.gov/downloads/ICECI/EnforcementActions/EnforcementStory/ EnforcementStoryArchive/UCM091079.pdf March 2006.
[11] Miranda EJ, McIntyre IM, Parker DR, Gary RD, Logan BK. Two deaths attributed to the use of 2,4-dinitrophenol. J Anal Toxicol. 2006 Apr;30(3):219-22. PubMed PMID: 16803658.
[12] Elrick H. Normal vs. optimal. J Natl Med Assoc. 2001 Oct;93(10):410-1. PubMed PMID: 11688922; PubMed Central PMCID: PMC2594072.
[13] Dickey RA, Wartofsky L, Feld S. Optimal thyrotropin level: normal ranges and reference intervals are not equivalent. Thyroid. 2005 Sep;15(9):1035-9. Review. PubMed PMID: 16187911.
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